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SA N 10AQ U I N Environmental Health Department <br /> ---COUNTY-- <br /> Crc n r + <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45°F(if food is used the following day, maintain below 41°F temperature): <br /> ® Ice chests ® Refrigerator <br /> ❑ Refrigerated truck ® Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. <br /> OR <br /> ® Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> solution (one tablespoon of bleach per gallon of water). <br /> ® Detergent, bleach, and wiping cloths(cleaning towels). <br /> ®Tub to store wiping cloths in bleach solution. <br /> 12. 1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> ®Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> ® One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> ® Paper towels and pump-style soap container. <br /> 13. Dames of responsible persons to be present in booth during all hours of operation: <br /> Sally Elsakr, Amera Salarna <br /> "Important*" All food vendor booths are subject to inspection. Please make a copy of this application in <br /> preparation for this event. A copy of this checklist must be in the booth at all hours of <br /> preparation and operation. Return original to festival coordinator three weeks prior to <br /> this event. <br /> 14, Completed by. Church Board Secretary 1219I2024 <br /> Signature Title Date <br /> 5-20 Gal <br /> Health Permit Hand`"ash Water <br /> Slemo wlChatfng <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutting Boartl Sanifizer bucket- <br /> blearh 8 water for <br /> Propane Stove Bleach storing wiping Cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywocd, or a Tarp. <br /> dt <br /> Propane Tank <br /> Soap and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> Fire Extinquisher <br /> t=xtra <br /> Water <br /> �Ce Cooler 5 Gal Hard wash <br /> Extra ke Begs 8 Food Containers must be Wastewater Container <br /> store!6 inches off of the ground? <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHp 16-02 Page 8 of 11 TEMP EVENT APP <br /> 0 7/0 1120 24 <br />